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Age-associated impact on presentation and outcome for penetrating thoracic trauma in the adult and pediatric patient populations

Mollberg, Nathan M. DO; Tabachnick, Deborah MD; Lin, Fang-Ju MS; Merlotti, Gary J. MD; Varghese, Thomas K. MD; Arensman, Robert M. MD; Massad, Malek G. MD

Journal of Trauma and Acute Care Surgery: February 2014 - Volume 76 - Issue 2 - p 273–278
doi: 10.1097/TA.0000000000000090
AAST 2013 Plenary Paper
Editor's Choice

BACKGROUND: Studies reporting on penetrating thoracic trauma in the pediatric population have been limited by small numbers and implied differences with the adult population. Our objectives were to report on a large cohort of pediatric patients presenting with penetrating thoracic trauma and to determine age-related impacts on management and outcome through comparison with an adult cohort.

METHODS: A Level I trauma center registry was queried between 2006 and 2012. All patients presenting with penetrating thoracic trauma were identified. Patient demographics, injury mechanism, injury severity, admission physiology, and outcome were recorded. Patients were compared, and outcomes were analyzed based on age at presentation, with patients 17 years or younger defining our pediatric cohort.

RESULTS: A total of 1,423 patients with penetrating thoracic trauma were admitted during the study period. Two hundred twenty patients (15.5%) were pediatric, with 205 being adolescents (13–17 years) and 15 being children (≤12 years). In terms of management for the pediatric population, tube thoracostomy alone was needed in 32.7% (72 of 220), whereas operative thoracic exploration was performed in 20.0% (44 of 220). Overall mortality was 13.6% (30 of 220). There was no significant difference between the pediatric and adult population with regard to injury mechanism or severity, need for therapeutic intervention, operative approach, use of emergency department thoracotomy, or outcome. Stepwise logistic regression failed to identify age as a predictor for the need for either therapeutic intervention or mortality between the two age groups as a whole. However, subgroup analysis revealed that being 12 years or younger (odds ratio, 3.84; 95% confidence interval, 1.29–11.4) was an independent predictor of mortality.

CONCLUSION: Management of traumatic penetrating thoracic injuries in terms of the need for therapeutic intervention and operative approach was similar between the adult and pediatric populations. Mortality from penetrating thoracic trauma can be predicted based on injury severity, the use of emergency department thoracotomy, and admission physiology for adolescents and adults. Children may be at increased risk for poor outcome independent of injury severity.

LEVEL OF EVIDENCE: Epidemiologic study, level III.

From the Division of Cardiothoracic Surgery (N.M.M., T.K.V.), Department of Surgery, University of Washington, Seattle, Washington; Divisions of Pediatric (R.M.A.), General (D.T.), Trauma (G.J.M.), and Cardiothoracic (M.G.M.) Surgery, Department of Surgery, University of Illinois at Mount Sinai Hospital; and Department of Pharmacy Administration (F.-J. L.), University of Illinois at Chicago, Chicago, Illinois.

Submitted: August 12, 2013, Revised: October 14, 2013, Accepted: October 14, 2013.

This paper was presented at the 72nd annual meeting for the American Association for the Surgery of Trauma, September 18–21, 2013, in San Francisco, California.

Address for reprints: Nathan M. Mollberg, DO, Department of Cardiothoracic Surgery, University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; email: nmollb@u.washington.edu.

© 2014 Lippincott Williams & Wilkins, Inc.